Changes in the esophageal mucosa of patients with non erosive reflux disease: How far have we gone?

Table 1 Histological criteria for the assessment of microscopic lesions described by Yerian et al[28]

Criterion	Definition and method of assessment (magnification)	Severity score
Basal cell hyperplasia	Measure basal cell layer in μm and express as a proportion of total epithelial thickness (× 10)	0 (absent < 15%), 1 (15%-30%), 2 (> 30%)
Papillary elongation	Measure papillary length in μm and express as a proportion (%) of total epithelial thickness (× 10)	0 (absent < 50%), 1 (50%-75%), 2 (> 75%)
Dilated intercellular spaces	Include irregular round dilations and diffuse widening of the intercellular space (× 40)	0 ( ≤ 5 small), 1 (≥ 6 small and ≤ 5 large) 2 (≥ 6 large)
	Small intercellular space= diameter < 1 lymphocyte
	Large intercellular spaces = diameter ≥ 1 lymphocyte
Intraepithelial eosinophils	Count cells in the most affected power field (× 40)	0 (0 cells in one high power field)
Intraepithelial neutrophils		1 (1-2 cells), 2 (> 2 cells)
Intraepithelial	Count cells in the most affected power field (× 40)	0 (0-9 cells)
mononuclear cells		1 (10-30 cells), 2 (> 30 cells)
Erosions	Assess as presence of at least one of the following: necrosis, granulation tissue or fibrin with neutrophils (× 10)	0 (absent), 1 (present)
Healed erosions	Assess as presence of granulation tissue covered by thinned regenerative epithelium (× 10) in the absence of necrosis, fibrin, and neutrophils	0 (absent), 1 (present)
Combined severity score	Sum of lesion severity scores divided by the number of lesions assessed (excludes intraepithelial monuclear cells and neutrophils, and erosions/healed erosions)
	0-0.25 normal mucosa, 0.5-0.75 mild esophagitis
	≥ 1 severe esophagitis

Biopsies were taken from the Z-line and at 2 cm above it.